28 Tex. Admin. Code § 11.2103 - Requirements for Issuance of Certificate of Authority to a CHMO
(a) Before obtaining a certificate of
authority, an applicant CHMO must comply with each requirement for the issuance
of a certificate of authority imposed on a limited health care service plan
under Insurance Code Chapter 843 (concerning Health Maintenance Organizations)
and Insurance Code Chapter 1271 (concerning Benefits Provided by Health
Maintenance Evidence of Coverage; Charges), this chapter, and other applicable
insurance laws and regulations of this state.
(b) A CHMO with a certificate of authority
must comply with all the appropriate requirements that a limited health care
service plan must comply with under Insurance Code Chapters 843 and 1271, this
chapter, and other applicable insurance laws and regulations of this state to
maintain a certificate of authority. A CHMO is subject to the same statutes and
rules as a limited service HMO and considered a limited service HMO for
purposes of regulation and regulatory enforcement.
(c) Nothing in this subchapter prevents one
or more community centers from forming a nonprofit corporation under
Occupations Code §
162.001 (concerning
Certification by Board) to provide services on a risk-sharing or capitated
basis as permitted under Insurance Code Chapter 844 (concerning Certification
of Certain Nonprofit Health Corporations).
(d) This subchapter does not apply to an
activity exempt from regulation under Insurance Code §
843.051 (concerning
Applicability of Insurance and Group Hospital Service Corporation Laws),
§843.053 (concerning Laws Relating to Restraint of Trade), §843.073 (concerning
Certificate of Authority Requirement; Applicability to Physicians and
Providers), or §843.318 (concerning Certain Contracts of Participating
Physicians or Provider Not Prohibited).
Notes
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